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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197419522
Report Date: 12/15/2021
Date Signed: 02/16/2022 01:44:42 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/23/2021 and conducted by Evaluator Stella Gutierrez
PUBLIC
COMPLAINT CONTROL NUMBER: 30-CC-20211123091836
FACILITY NAME:CREATIVE HANDS LEARNING ACADEMYFACILITY NUMBER:
197419522
ADMINISTRATOR:MADISON, NATASHA LORENEFACILITY TYPE:
850
ADDRESS:2320 W. MARTIN LUTHER KINGTELEPHONE:
(310) 462-6097
CITY:LOS ANGELESSTATE: CAZIP CODE:
90008
CAPACITY:63CENSUS: 36DATE:
12/15/2021
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Natasha MadisonTIME COMPLETED:
10:59 AM
ALLEGATION(S):
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Physical Plant
INVESTIGATION FINDINGS:
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This is an amended report that will supersede complaint report dated 12/14/2021.

On 2/16/2022 at 1:41PM Licensing Program Analyst (LPA) Meghan McGee made an unannounced visit to Creative Hands Learning Academy for the purpose to deliver findings of a complaint that was received at the El Segundo Regional Office on 11/23/2021. LPA McGee was greeted by Natasha Madison, Administrator and was explained the purpose of today’s visit.

The allegation of Physical Plant was investigated. Based on interviews conducted and information received, it was revealed that a child did sustain an injury while in care and the allegation is deemed substantiated, meaning that the allegation is valid because the preponderance of the evidence standard has been met. Administrator provided a written declaration stating that the child sustained an injury from a table at the facility that was not maintained and free from sharp objects which resulted in a child sustaining an injury. Since the incident occurred, the Facility Administrator has removed the table from premises.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Meghan McGee
LICENSING EVALUATOR SIGNATURE:

DATE: 02/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 30-CC-20211123091836
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: CREATIVE HANDS LEARNING ACADEMY
FACILITY NUMBER: 197419522
VISIT DATE: 12/15/2021
NARRATIVE
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There will be a type A deficiency cited during today's inspection.

A copy of this report must be provided to the authorized representatives of all currently enrolled children and any newly enrolled child for the following 12 months.

The ACKNOWLEDGEMENT OF RECEIPT OF LICENSING REPORTS (LIC9224) shall be signed and kept in each of the children’s records. The report shall be provided no later than the next business day or the next operating day.

Exit interview conducted. Type A deficiency cleared during todays inspection. A copy of this report was discussed and provided to Licensee along with a notice of site visit that shall be posted with full report for no less than 30 days of today's date.

SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Stella Gutierrez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 30-CC-20211123091836
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: CREATIVE HANDS LEARNING ACADEMY
FACILITY NUMBER: 197419522
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/15/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/13/2021
Section Cited
CCR
101239(n)
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101239 Fixtures, Furniture, Equipment and Supplies
(n) Furniture and equipment shall be maintained in good condition, free of sharp, loose or pointed parts.
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Since the incident occurred that table has been removed and no longer present at the facility. Type A deficiency cleared during today's visit.
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Based on interviews and information received this standard was not met by evidence of Administrator verbal statement and provided on a declaration that a table at the facility was not free from sharp items and that a child sustained an injury from the table.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Stella Gutierrez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/15/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2021
LIC9099 (FAS) - (06/04)
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